MEDICARE: NICHOLLE STURM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SZ8679	FL
2	222Q00000X	Developmental Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386943330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLLE STURM

Provider Business Mailing Address
First Line	:	3663 CROWN POINT CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5967
Country	:	US
Telephone Number	:	904-228-8910
Fax Number	:	904-288-8912

Provider Business Practice Location Address
First Line	:	3663 CROWN POINT CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5967
Country	:	US
Telephone Number	:	904-288-8912
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2011
Last Update Date	:	01/30/2019

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Directions to “ NICHOLLE STURM ” Practice Location

Language	Start Address	Practice Location

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